Digital therapeutics in neurology

AbstractDigital therapeutics (DTx) is a section of digital health defined by the DTx Alliance as “delivering evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes”. Chronic disabling diseases could greatly benefit from DTx. In this narrative review, we provide an overview of DTx in the care of patients with neurological dysfunctions.

Download Full-text

Effectiveness of Evidence-based Pneumonia CPOE Order Sets Measured by Health Outcomes

Online Journal of Public Health Informatics ◽

10.5210/ojphi.v7i2.5527 ◽

2015 ◽

Vol 7 (2) ◽

Cited By ~ 7

Author(s):

Jacob Krive ◽

Joel S. Shoolin ◽

Steven D. Zink

Keyword(s):

Health Outcomes ◽

Patient Care ◽

Cost Of Care ◽

Patient Treatment ◽

Computerized Physician Order Entry ◽

Evidence Based ◽

Order Entry ◽

Order Sets ◽

Physician Order Entry ◽

Order Set

ObjectiveEvidence-based sets of medical orders for the treatment of patients with common conditions have the potential to induce greater efficiency and convenience across the system, along with more consistent health outcomes. Despite ongoing utilization of order sets, quantitative evidence of their effectiveness is lacking. In this study, conducted at Advocate Health Care in Illinois, we quantitatively analyzed the benefits of community acquired pneumonia order sets as measured by mortality, readmission, and length of stay (LOS) outcomes.MethodsIn this study, we examined five years (2007–2011) of computerized physician order entry (CPOE) data from two city and two suburban community care hospitals. Mortality and readmissions benefits were analyzed by comparing “order set” and “no order set” groups of adult patients using logistic regression, Pearson’s chi-squared, and Fisher’s exact methods. LOS was calculated by applying one-way ANOVA and the Mann-Whitney U test, supplemented by analysis of comorbidity via the Charlson Comorbidity Index.ResultsThe results indicate that patient treatment orders placed via electronic sets were effective in reducing mortality [OR=1.787; 95% CF 1.170-2.730; P=.061], readmissions [OR=1.362; 95% CF 1.015-1.827; P=.039], and LOS [F (1,5087)=6.885, P=.009, 4.79 days (no order set group) vs. 4.32 days (order set group)].ConclusionEvidence-based ordering practices have the potential to improve pneumonia outcomes through reduction of mortality, hospital readmissions, and cost of care. However, the practice must be part of a larger strategic effort to reduce variability in patient care processes. Further experimental and/or observational studies are required to reduce the barriers to retrospective patient care analyses.Keywords: evidence-based medicine, medication order sets, health outcomes research, pneumonia, computerized physician order entry (CPOE).

Download Full-text

Interdisciplinary Collaboration among Health Professionals: A Panacea for effective and Evidence-based Health Care delivery

Journal of Radiography and Radiation Sciences ◽

10.48153/jrrs/2020/xqyr3082 ◽

2020 ◽

Vol 34 (1) ◽

pp. 12-23

Author(s):

Joseph D Z ◽

Aminu B ◽

Halilu S ◽

Mark A D ◽

Kayode O ◽

...

Keyword(s):

Health Care ◽

Health Outcomes ◽

Patient Care ◽

Health Professionals ◽

Health Care Professionals ◽

Interdisciplinary Collaboration ◽

Healthcare Delivery ◽

Evidence Based ◽

Search Term ◽

The Impact

Introduction: Interdisciplinary collaboration (IDC) is important in health care settings as the complex nature and demands of the health care work environment requires the expertise and knowledge of different individuals or specialists working together to solve multifaceted and complex patient care problems. Objective: To assess the health professionals' attitude towards the development of an interdisciplinary collaborative approach to patient care in health institutions and to systematically review the impact of IDC as a panacea for effective health outcomes in Nigeria. Methodology: The research is a systematic review that provides various approaches for studying interdisciplinary teams. Fifty articles were selected from different search engines such as Google, google scholar, science direct and research gate with the search term Interdisciplinary collaboration among health care professionals. Articles were arranged based on most relevant, relevant and closely related articles. Result: The study revealed that IDC is pivotal in evidence-based care and contributes immensely to effective and efficient health outcomes. It puts the patient at the centre of the healthcare team's focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes. Although there are several obstacles to IDC, adopting this team-based culture of mutual respect and understanding is possible and, in fact, necessary. Conclusion: This study reveals that there are many benefits to IDC. It can improve safety and healthcare delivery, as well as reduce costs. The interprofessional team supports patient and personnel engagement, organizational efficiency and innovation.

Download Full-text

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd20.4.121 ◽

2011 ◽

Vol 20 (4) ◽

pp. 121-123

Author(s):

Jeri A. Logemann

Keyword(s):

Decision Making ◽

Patient Care ◽

Clinical Outcomes ◽

Clinical Judgment ◽

Clinical Decision Making ◽

Evidence Based Practice ◽

Clinical Decision ◽

Evidence Based ◽

Clinical Method ◽

Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Download Full-text

Patient Care Needs Assessment: An Evidence-Based Process to Inform Quality Care and Decision Making

PsycEXTRA Dataset ◽

10.1037/e570112013-017 ◽

2013 ◽

Author(s):

Ross Riggs ◽

Robert Miller ◽

Wynne de Jong

Keyword(s):

Decision Making ◽

Patient Care ◽

Needs Assessment ◽

Quality Care ◽

Evidence Based ◽

Care Needs

Download Full-text

Are We Paving the Way to Dig Out of the “Pandemic Hole”? A Narrative Review on SARS-CoV-2 Vaccination: From Animal Models to Human Immunization

Medical Sciences ◽

10.3390/medsci9030053 ◽

2021 ◽

Vol 9 (3) ◽

pp. 53

Author(s):

Giuseppe Tardiolo ◽

Pina Brianti ◽

Daniela Sapienza ◽

Pia dell’Utri ◽

Viviane Di Dio ◽

...

Keyword(s):

Animal Models ◽

Viral Vector ◽

Herd Immunity ◽

Population Level ◽

Narrative Review ◽

Therapeutic Interventions ◽

Preclinical Research ◽

Inactivated Vaccines ◽

Preclinical And Clinical Studies ◽

Social Upheaval

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a new pathogen agent causing the coronavirus infectious disease (COVID-19). This novel virus originated the most challenging pandemic in this century, causing economic and social upheaval internationally. The extreme infectiousness and high mortality rates incentivized the development of vaccines to control this pandemic to prevent further morbidity and mortality. This international scenario led academic scientists, industries, and governments to work and collaborate strongly to make a portfolio of vaccines available at an unprecedented pace. Indeed, the robust collaboration between public systems and private companies led to resolutive actions for accelerating therapeutic interventions and vaccines mechanism. These strategies contributed to rapidly identifying safe and effective vaccines as quickly and efficiently as possible. Preclinical research employed animal models to develop vaccines that induce protective and long-lived immune responses. A spectrum of vaccines is worldwide under investigation in various preclinical and clinical studies to develop both individual protection and safe development of population-level herd immunity. Companies employed and developed different technological approaches for vaccines production, including inactivated vaccines, live-attenuated, non-replicating viral vector vaccines, as well as acid nucleic-based vaccines. In this view, the present narrative review provides an overview of current vaccination strategies, taking into account both preclinical studies and clinical trials in humans. Furthermore, to better understand immunization, animal models on SARS-CoV-2 pathogenesis are also briefly discussed.

Download Full-text

Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽

10.1159/000515663 ◽

2021 ◽

pp. 1-14

Author(s):

R. James Stubbs ◽

Cristiana Duarte ◽

António L. Palmeira ◽

Falko F. Sniehotta ◽

Graham Horgan ◽

...

Keyword(s):

Weight Loss ◽

Behaviour Change ◽

Digital Health ◽

Self Regulation ◽

Self Management ◽

Behaviour Change Techniques ◽

Evidence Based ◽

Behavioural Science ◽

Digital Architecture

Background: Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. The Project: First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. Impact: The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

Download Full-text

Undernutrition and HIV Infection in Sub-Saharan Africa: Health Outcomes and Therapeutic Interventions

Current HIV/AIDS Reports ◽

10.1007/s11904-021-00541-6 ◽

2021 ◽

Vol 18 (2) ◽

pp. 87-97

Author(s):

Hubaida Fuseini ◽

Ben A. Gyan ◽

George B. Kyei ◽

Douglas C. Heimburger ◽

John R. Koethe

Keyword(s):

Hiv Infection ◽

Health Outcomes ◽

Sub Saharan Africa ◽

Therapeutic Interventions ◽

Sub Saharan

Download Full-text

Building capacity for implementation—the KT Challenge

Implementation Science Communications ◽

10.1186/s43058-021-00186-x ◽

2021 ◽

Vol 2 (1) ◽

Author(s):

Agnes T. Black ◽

Marla Steinberg ◽

Amanda E. Chisholm ◽

Kristi Coldwell ◽

Alison M. Hoens ◽

...

Keyword(s):

Health Care ◽

Patient Care ◽

Health Care Professionals ◽

Qualitative Data ◽

Practice Change ◽

Evidence Based ◽

Science Literature ◽

Health Care Settings ◽

Improvement Programs ◽

The Impact

Abstract Background The KT Challenge program supports health care professionals to effectively implement evidence-based practices. Unlike other knowledge translation (KT) programs, this program is grounded in capacity building, focuses on health care professionals (HCPs), and uses a multi-component intervention. This study presents the evaluation of the KT Challenge program to assess the impact on uptake, KT capacity, and practice change. Methods The evaluation used a mixed-methods retrospective pre-post design involving surveys and review of documents such as teams’ final reports. Online surveys collecting both quantitative and qualitative data were deployed at four time points (after both workshops, 6 months into implementation, and at the end of the 2-year funded projects) to measure KT capacity (knowledge, skills, and confidence) and impact on practice change. Qualitative data was analyzed using a general inductive approach and quantitative data was analyzed using non-parametric statistics. Results Participants reported statistically significant increases in knowledge and confidence across both workshops, at the 6-month mark of their projects, and at the end of their projects. In addition, at the 6-month check-in, practitioners reported statistically significant improvements in their ability to implement practice changes. In the first cohort of the program, of the teams who were able to complete their projects, half were able to show demonstrable practice changes. Conclusions The KT Challenge was successful in improving the capacity of HCPs to implement evidence-based practice changes and has begun to show demonstrable improvements in a number of practice areas. The program is relevant to a variety of HCPs working in diverse practice settings and is relatively inexpensive to implement. Like all practice improvement programs in health care settings, a number of challenges emerged stemming from the high turnover of staff and the limited capacity of some practitioners to take on anything beyond direct patient care. Efforts to address these challenges have been added to subsequent cohorts of the program and ongoing evaluation will examine if they are successful. The KT Challenge program has continued to garner great interest among practitioners, even in the midst of dealing with the COVID-19 pandemic, and shows promise for organizations looking for better ways to mobilize knowledge to improve patient care and empower staff. This study contributes to the implementation science literature by providing a description and evaluation of a new model for embedding KT practice skills in health care settings.

Download Full-text

A Review of Evidence-Based Recommendations for Pericoronitis Management and a Systematic Review of Antibiotic Prescribing for Pericoronitis among Dentists: Inappropriate Pericoronitis Treatment Is a Critical Factor of Antibiotic Overuse in Dentistry

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18136796 ◽

2021 ◽

Vol 18 (13) ◽

pp. 6796

Author(s):

Jan Schmidt ◽

Martina Kunderova ◽

Nela Pilbauerova ◽

Martin Kapitan

Keyword(s):

Systematic Review ◽

Local Therapy ◽

Critical Factor ◽

Antibiotic Use ◽

Narrative Review ◽

Antibiotic Prescribing ◽

Evidence Based ◽

Antibiotic Overuse ◽

Clinically Significant

This work provides a narrative review covering evidence-based recommendations for pericoronitis management (Part A) and a systematic review of antibiotic prescribing for pericoronitis from January 2000 to May 2021 (Part B). Part A presents the most recent, clinically significant, and evidence-based guidance for pericoronitis diagnosis and proper treatment recommending the local therapy over antibiotic prescribing, which should be reserved for severe conditions. The systematic review includes publications analyzing sets of patients treated for pericoronitis and questionnaires that identified dentists' therapeutic approaches to pericoronitis. Questionnaires among dentists revealed that almost 75% of them prescribed antibiotics for pericoronitis, and pericoronitis was among the top 4 in the frequency of antibiotic use within the surveyed diagnoses and situations. Studies involving patients showed that antibiotics were prescribed to more than half of the patients with pericoronitis, and pericoronitis was among the top 2 in the frequency of antibiotic use within the monitored diagnoses and situations. The most prescribed antibiotics for pericoronitis were amoxicillin and metronidazole. The systematic review results show abundant and unnecessary use of antibiotics for pericoronitis and are in strong contrast to evidence-based recommendations summarized in the narrative review. Adherence of dental professionals to the recommendations presented in this work can help rapidly reduce the duration of pericoronitis, prevent its complications, and reduce the use of antibiotics and thus reduce its impact on patients' quality of life, healthcare costs, and antimicrobial resistance development.

Download Full-text